Introduction to the Endovascular Section
Josef E. Fischer
Since the last edition, stenting, endovascular opening of thromboses, and the growth of minimally invasive surgery extended to vascular have revolutionized the field of vascular surgery. They have also created a new necessity for training, as the traditional open vascular training is relatively straightforward and similar to that of open general surgical training in the area of gastrointestinal and other open techniques. Endovascular surgery, which is the rapid growth area of the field, seems destined to continue to surpass open surgery as the field matures and changes.
Already there are indications that, for example, aortoiliac endovascular surgery, while having a slightly less long-term patency rate of, say, 97%, as compared to 99% in open aortoiliac surgery, is almost certain to improve with time as the technology advances. In the past 5 years, we have seen enormous strides in the nature of the stents, their seating capacity, the reduction of various types of endo leaks, and the ability to maintain long-term patency. This will continue. The benefits to the patients, of which the most dramatic is the replacement of aortic aneurysmal resection, are striking. To me, who voluntarily stopped doing vascular surgery in 1976 because of a more profound interest in complicated gastrointestinal surgery and reoperative gastrointestinal surgery for fistulas, watching the continued performance of resection and grafting of aortic aneurysm meant 1 to 3 days in the intensive care unit (ICU), a 10-day hospital stay, a long incision from the xiphoid to pubis, and considerable morbidity. Contrast this with the overnight stay, a small groin incision, no stays in the ICU (but in an step-down unit), and, barring an occasional disastrous complication such as a retroperitoneal hole in the internal ileac artery due to a misplaced stent, really a benign postoperative course and low mortality.